Tobaruela E, Camuñas J, Enríquez-Navascúes J M, Díez M, Ratia T, Martín A, Hernández P, Lasa I, Martín A, Cambronero J A, Granell J
Servicio de Cirugía General y Digestiva, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid.
Rev Esp Enferm Dig. 1997 Jan;89(1):13-22.
To review the results of the analysis and quantification of the influence of medical factors on the morbidity and mortality associated with emergency surgery for colorectal cancer.
We analyze retrospectively the data for 51 patients who underwent emergency surgery: 34 (67%) to treat acute obstruction and 17 (33%) for perforation. The median follow-up period was 18.5 months (3 to 62 months).
The main tumor was located in the right colon in 13 patients (25%), in the left colon in 35 (69%) and in, the rectum in 3 (6%). Primary resection was performed in 94% of the patients: without anastomosis in 35% (18 of 51) and with primary anastomosis in 59% (30 of 51); 6% of the tumors were not resectable. The postoperative morbidity was 41%: 29% (10 of 34) occurring in obstructions and 65% (11 of 17) in perforations. The mortality rate was 14% (9% and 23%, respectively). There were statistically significant associations between mortality and the American Society of Anesthesia grading (p < 0.01) and between both the mortality and morbidity and the score for the acute physiology component of APACHE II (p = 0.01, respectively) and the total APACHE II score (p < 0.01 in both cases). The rate of actuarial disease-free survival was 26% at 36 months. Overall survival was 15% at 62 months. A recurrence rate of 48% (14 of 29) has been recorded.
Emergency surgery for colorectal cancer is associated with a high postoperative morbidity and mortality rate, which correlate with the medical status and, particularly, with the acute physiology score of the APACHE II risk stratification system.
回顾分析和量化医疗因素对结直肠癌急诊手术相关发病率和死亡率影响的结果。
我们回顾性分析了51例行急诊手术患者的数据：34例（67%）因治疗急性肠梗阻接受手术，17例（33%）因穿孔接受手术。中位随访期为18.5个月（3至62个月）。
主要肿瘤位于右半结肠13例（25%），左半结肠35例（69%），直肠3例（6%）。94%的患者进行了一期切除：35%（51例中的18例）未行吻合，59%（51例中的30例）进行了一期吻合；6%的肿瘤无法切除。术后发病率为41%：肠梗阻患者中为29%（34例中的10例），穿孔患者中为65%（17例中的11例）。死亡率为14%（分别为9%和23%）。死亡率与美国麻醉医师协会分级之间存在统计学显著关联（p < 0.01），死亡率和发病率与急性生理学及慢性健康状况评分系统（APACHE II）的急性生理学部分评分（分别为p = 0.01）以及APACHE II总分（两种情况均为p < 0.01）之间也存在统计学显著关联。36个月时无病生存率为26%。62个月时总生存率为15%。记录到的复发率为48%（29例中的14例）。
结直肠癌急诊手术术后发病率和死亡率较高，这与患者的医疗状况相关，尤其是与APACHE II风险分层系统的急性生理学评分相关。
